Dialysis interruption caused by voluntary quarantine against the coronavirus disease (COVID-19) in a patient on maintenance hemodialysis after returning from overseas to Japan.

Dear Editor,

End‐stage renal disease (ESRD) is the last stage of chronic kidney disease (CKD). Besides kidney transplantation, dialysis therapy has been established as an effective life‐prolonging treatment for patients with ESRD. However, since dialysis therapy is not a curative treatment against renal impairment, interruption of dialysis can be fatal due to severe complications of ESRD, such as serious congestive heart failure, hyperkalemia or uremia. Herein, we present the case of a Japanese patient on maintenance hemodialysis (HD) who was forced to interrupt HD for 7 days because of voluntary quarantine against the coronavirus disease (COVID‐19) after returning from overseas.

A 47‐year‐old man with ESRD on maintenance HD using a tunneled HD catheter was admitted to the hospital with dyspnea and general malaise. He lived in the United States up until a week earlier, and was voluntarily quarantining and staying at a hotel without undergoing HD after returning to Japan. On admission, his body weight was 56.2 kg, about 9 kg higher than his usual post‐dialysis weight. His temperature was 37.2°C, respiratory rate was 14 breaths/min, and oxygen saturation (SpO2) was 91% on room air. He was found to have bilateral butterfly shadows on chest X‐ray and central ground glass opacification and bilateral pleural effusion on chest computed tomography (Figure 1). The main findings from blood tests on admission were as follows: blood urea nitrogen, 108.7 mg/dL; creatinine, 12.95 mg/dL; potassium, 6.7 mmol/L; and C‐reactive protein, 3.24 mg/dL. The result of a real‐time reverse transcriptase polymerase chain reaction test for severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) was negative. He was diagnosed with pulmonary edema and uremia caused by interruption of HD, and subsequently rapidly improved after restart of HD.

FIGURE 1

Chest X‐ray and computed tomography on admission. A, Chest X‐ray showed bilateral butterfly shadows. B, Chest computed tomography showed central ground glass opacification and bilateral pleural effusion

SARS‐CoV‐2 has spread widely all over the world and COVID‐19 caused by SARS‐CoV‐2 has become a worldwide health threat. Therefore, the Japanese government has asked people returning from overseas to voluntarily quarantine themselves for 14 days in these present circumstances. However, this case report demonstrates that there are some important problems in this self‐quarantine of patients undergoing maintenance HD. First, dialysis facilities where quarantine is possible for international travelers returning to Japan need to be secured for HD patients in quarantine. Second, clinical data and information on the maintenance HD, which the patient was receiving in the country of travel origin, is required by the dialysis facility in Japan, which might be difficult because the travel might have occurred suddenly without much preplanning in terms of obtaining medical records. Third, specific precautions against COVID‐19 need to be established at the dialysis facility to reduce transmission to other HD patients and staff.2, 3

In conclusion, we think it necessary to establish social and medical systems around transboundary travel in order to ensure the safety and protect the lives of patients undergoing maintenance HD during the COVID‐19 pandemic. While preparing the system of our own countries, international information sharing is also important.